Update from the Core Steering Group Deputy-Chair, Josette Roussel
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Editors: Sini Hämäläinen RN, MHC, NP and Marie-Lyne Bournival BSc, PG Health Sc, MN, NP Update from the Core Steering Group Deputy- Chair, Josette Roussel Dear Colleagues, As the upcoming ICN NP/APN Network Deputy-Chair I am writing this column for the May Network Bulletin in the midst of the second year of a global pandemic. I wish to first acknowledge the leadership and excellent work of Dr Melanie Rogers, current Chair of the network as well as Daniela Lehwaldt who will take over as Chair. It has been a privilege to work alongside these APN leaders to continue the important and unique work of the ICN NP/APNN. The world is accelerating the vaccination programme for COVID-19 and many countries are still confined to minimise the impact of the third wave on the health of their population. Advanced practice nurses are at the forefront of the pandemic and have been providing essential care and services. The Network subgroups are very busy advancing many initiatives and projects during an exceptional year. As the upcoming deputy chair for the Network, I bring more than three decades of experience in the Canadian healthcare sector in a variety of nursing roles including 20 years’ work in advanced nursing practice. Most recently, I took on a new challenge in a new executive leadership position within a hospital. I have been contributing to the Network for more than a decade as a member of the health policy subgroup and the core steering group (CSG) responsible for membership, conference planning and on the executive. As a member of the executive organising committee for the upcoming 11th ICN NP/APN virtual congress, I am pleased to bring greetings from Canada and invite you to register for this amazing conference programme. http://npapn2021.com During my 33-year career, I have been driven by a vision to lead and contribute to publicly funded healthcare, advance nursing practice and the development of new evidence within regional, national and international levels to strengthen nursing leadership. I completed graduate degrees in nursing and education, and bring a deep knowledge of Canadian nursing in all my work. As a former nurse leader at the Canadian Nurses Association, I have made many achievements to advance public policy supporting APN at the national and international levels. I developed and fostered strategic alliances and collaborations to successfully position APN in national research grants, in federal policy and legislative committees to enable better care, better value and optimize APN roles within the Canadian healthcare system. My leadership contributed to advance the following: advanced nursing practice framework, policy papers on clinical nurse specialist and nurse practitioner, federal policy legislation to enable nurse practitioner roles as well as supporting research and promotion of these roles in healthcare. As the CSG Deputy-Chair I look forward to working closely with the upcoming CSG Chair, to advance the Network and CSG leadership. The Deputy-Chair shares responsibilities with the CSG Chair for the Network and conference planning as well as linkages with ICN to position APN leadership and roles.
Looking forward to supporting and working with the CSG Chair and its subgroup leaders!
Josette Roussel RN, MSc, MEd
Table of Contents
Update from the Core Steering Group Deputy-Chair, Josette Roussel
Recent awards
Minna Miller
Deborah Gray
Healthcare for Indigenous People and the Advanced Practice Nurse: A Canadian Context
Elissa Ladd - Interview with an awarded APN pioneer
ICN NP/APNN COVID-19 update
Resilience of APNs during COVID-19 crisis – An international study
11th ICN NP/APN Network Conference goes virtual
Recent awards
By Sini Hämäläinen
Photos: Minna Miller, Deborah Gray
Minna Miller
In February, 2021 CSG Project Coordinator Dr Minna Miller was honoured with a Frontline Hero 2020 Honorary
Medal of Gratitude by the Provincial Health Services Authority in British Columbia, Canada. The handmade,
sterling silver, medal was designed by a former nurse, to honour frontline workers who have been risking their own
safety and well-being during COVID-19 crisis to help others.
Deborah Gray ICN NP/APNN member, Research Subgroup Co-Chair, and Deputy Director Global Academy of Research and Enterprise, Dr Deborah Gray, ANP-BC, FNP-C, FAANP, was recently selected as the recipient of the 2021 Provost's Award for Leadership in International Education at her institution, Old Dominion University in Virginia, USA. This award was established in 2001 and is awarded yearly to recognise an Old Dominion faculty member who has provided outstanding excellence and leadership in strengthening the University's international mission. Dr Gray is being recognised for her international contributions at the University, as well as her work as a US Fulbright Scholar in Sub-Saharan Africa with the University of Botswana, University of Ghana, and the WHO Collaboration Center for Nursing and Midwifery, and her efforts with the ICN NP/APNN, the United Nations Foundation, and other international organisations. Healthcare for Indigenous People and the Advanced Practice Nurse: A Canadian Context By Colette Henderson, MSc, BSc(Hons) NP, PgCert NP, RN, NISP, RNT, FHEA and Stan Marchuk, DNP, MN, NP(F), CNeph(c), FAANP Inconsistencies in healthcare have been found in 28 indigenous populations from 23 countries.(1) Access to good quality healthcare is one of the key social determinants of health.(2) Inequity in terms of access to healthcare exists specifically among indigenous populations leaving them exposed and vulnerable.(3,4) The ostracism and inequity contribute to significantly higher morbidity and mortality and a risk of poorer healthcare outcomes.(3,4) This risk is further increased for indigenous communities living in remote and rural areas.(4) Many complex and interdependent factors affect indigenous people accessing healthcare.(3) Colonisation established a strategy of ‘cultural genocide’(5) which supported marginalisation and disempowerment of indigenous populations. In addition to historical influences, accessibility of healthcare services from both a geographical and financial perspective, lack of awareness of and variation in available services further influence healthcare access.(3) The right to self-determination is assumed to be associated with a fully informed choice but, if healthcare education and knowledge is lacking, this informed choice cannot be assumed.(3) Research findings indicate variation exists across countries and within indigenous populations, but countries that have adopted inclusive social, political, cultural and economic policies can demonstrate improved healthcare outcomes.(1) As a unique and socially responsible practitioner, the Advanced Practice Nurse can play a key leadership role in supporting and transforming healthcare to ensure equitable and culturally safe healthcare is available to all.6
Educators of advanced practice nurses should seek to ensure advanced practice programmes provide real
opportunities for the development of capability in the provision of culturally safe and appropriate care.
In Canada, the Truth and Reconciliation Commission(7) and the United Nations Declaration on the Rights of
Indigenous Peoples(8) form the framework for addressing health and social inequities and for reconciliation in
Canadian society. Nurses condemn all acts of racism and discrimination against Indigenous Peoples and call for
social justice to address health inequities across our country.
In recognition of inequities, the Canadian Nurses Association (CNA) resolved to adopt the Aboriginal Nursing
Strategic Plan to ensure health inequalities in Canada are addressed.(9) It is argued that a robust understanding
and appreciation of the historical context is vital to ensure current and future policy context is inclusive and non-
discriminatory(5) and this requires national engagement and action.
Advanced Practice Nurses, working in many of Canada’s rural and remote communities play a vital role in
addressing health inequities for Indigenous Peoples in Canada. APNs, having served these communities for
decades, are often the only healthcare professionals in many settings and have the opportunity to work with
Indigenous communities to create and deliver culturally safe care; bring care closer to where Indigenous people live,
work, play, and learn; and deploy providers and resources to address the challenging settings and healthcare needs
of the community.(10)
To further advance future health systems partnerships and healing with Indigenous Peoples in Canada, nursing
needs to value the traditional practices and be open to building relationships with Indigenous healing practitioners,
Knowledge Keepers and Elders.(10)
References
1. Anderson, I., Robson, B., Connolly, M et al (2016) Indigenous and tribal peoples’ health (The Lancet–Lowitja Institute Global Collaboration): a
population study Lancet 2016; 388: 131–57.
2. World Health Organisation (2021) Social Determinants of Health. Available at: https://www.who.int/health-topics/social-determinants-of-
health#tab=tab_1 Accessed 15/02/2021.
3. Horrill, T., McMillan, D.E., Schultz, A.S.H., and Thompson, G (2018) Understanding access to healthcare among Indigenous peoples: A
comparative analysis of biomedical and postcolonial perspectives Nursing Inquiry 25: e 12237 doi: 10.1111/nin.12237.
4. McCullough, K., Whitehead, L., Bayes, S., Williams, A., and Cope, L. (2020) The delivery of Primary Health Care in remote communities: A
Grounded Theory study of the perspective of nurses International Journal of Nursing Studies 102, 103474
https://doi.org/10.1016/j.ijnurstu.2019.103474
5. Truth and Reconciliation Commission for Canada (2015) Honouring the Truth, Reconciling for the Future Summary of the Final Report of the Truth
and Reconciliation Commission of Canada Available at: http://nctr.ca/assets/reports/Final%20Reports/Executive_Summary_English_Web.pdf
(Accessed 19/02/2021).
6. International Council of Nurses (2020) Guidelines on Advanced Practice Nursing. Available at: https://www.icn.ch/system/files/documents/2020-
04/ICN_APN%20Report_EN_WEB.pdf (Accessed 19/02/2021).
7. Truth and Reconciliation Commission for Canada (2015) Truth and reconciliation commission of Canada: Calls to Action Available
at: https://www.google.com/search?client=safari&rls=en&q=truth+and+reconciliation+commission+of+canada+calls+to+action&ie=UTF-
8&oe=UTF-8 (Accessed 01.04.2021).
8. Canadian Public Health Association (2018) Racism and public health Available at: https://www.cpha.ca/racism-and-public-health (Accessed
01.04.2021).
9. Canadian Nurses Association/Aboriginal Nurses Association of Canada (2014) Aboriginal Health Nursing and Aboriginal Health: Charting Policy
Direction for Nursing in Canada Canadian Nurses Association: Ottawa.
10. Allen, L., Hatala, A., Ijaz, S., Courchene, E. D., & Bushie, E. B. (2020). Indigenous-led health care partnerships in Canada. Canadian Medical
Association Journal, 192(9), E208–E216. https://doi.org/10.1503/cmaj.190728
Elissa Ladd - Interview with an awarded APN pioneer
By Ivy MuyaDr Elissa Ladd received her undergraduate degree from the University of Pennsylvania, MSc degree from Rush University, and PhD from the University of Massachusetts. Dr Ladd has worked as a nurse in healthcare settings around the world. She volunteered with midwives in a maternity center in Lima, Peru, served as a Commissioned Officer with the Indian Health Service on the Navaho Indian Reservation, and worked in refugee camps on the Thai/Cambodian border. Her global work continued within the context of her academic career as a consultant in the development of a nurse practitioner programme at Walter Sisulu University in South Africa and as a Fulbright Scholar at Manipal University in South India. There she served as a professor and mentor to students and faculty in the College of Nursing, focusing on research and nursing practice innovations. She went on to create an academic partnership between Manipal and the MGH IHP which now supports bidirectional student and faculty immersion programmes. Dr Ladd received funding from the US-India Educational Foundation to promote expanded capacity in inter-professional health professions education. Dr Ladd’s research focuses on practice and policies that pertain to nurse prescribing in domestic and global arenas. She has lectured and published widely on policy topics that relate to pharmaceutical practice and advanced practice nursing. She is a member of the ICN/APNN CSG and was appointed as a Co-Director of its Global Academy of Research and Enterprise. In 2019, Dr Ladd was the recipient of the Inspiring Global Nurse Award by Nurses with Global Impact at the United Nations and, in 2020, she was inducted as a Fellow into the American Academy of Nursing. Q: From a global perspective, what would you do to improve and or encourage the nurses in the world to focus on? A: I think one of the biggest challenges that nurses face around the world is the ability to embrace their role as leaders in healthcare. They need to feel confident and empowered by their education, skills and experience in order to effectively participate in leadership roles in their countries. We are the largest segment of the healthcare workforce worldwide, and it is imperative that we have a seat at the table if we are going to move our goals of universal, equitable, care forward. And, in the words of Shirley Chisholm, a great American Congresswoman and civil rights leader, “If they don’t give you a seat at the table, bring a folding chair”. Q: What motivates you as a nurse? A: The students and new nurses that I teach and mentor. The profession has changed greatly over the course of my career and I feel that they have the skills, intellect and, importantly, the values to shepherd our profession as leaders in healthcare through the 21st Century. Q: Does the modern-day role of a nurse conflict with what a nurse was perceived to be? A: I think it depends on who the audience is. Many people in healthcare understand the capabilities of nurses and the importance of their role in the healthcare team. There has been some conflict as of late, however, in terms of the growing role that advanced practice nurses have, especially nurse practitioners. I think that this is an indication of the growing pains of roles that are evolving and changing and a health system’s ability to embrace the organic change that is occurring in many countries. Q: What exactly do you do and how would it impact nurses in low- and Middle-income countries? A: One of things that I have been working on over the past 20 years is helping to increase capacity for post-basic, advanced practice and faculty level roles in different parts of the world, including my own. In terms of low-middle income countries, I have been working with a university in South India for the past 10 years where I have focused on empowerment of nurses, especially in clinical positions as well as introducing interprofessional education and
collaboration as a way to enhance communication and elevate the status of nurses. Through my faculty role there, I have participated in numerous educational, community and government events as well as consulted regarding the implementation of a new nurse practitioner programme. In terms of interprofessional education, with support from a collaborative programme between the Government of India and the US State Department, my colleagues in India along with colleagues from the US developed a series of interprofessional training programmes for both faculty and students. Q: What is your ‘pay-it-forward’ take when it comes to the nursing profession? A: I have been fortunate over the past five years to work with the ICN NP/APNN. This has been a truly rewarding experience. First as Chair of the Health Policy Subgroup, and now as a Deputy Directory of the Academy of Research and Enterprise, as well as a member of the Core Steering Group, I have learned a tremendous amount from my colleagues from around the world. Importantly, it has become very clear to me that the role of the advanced practice nurse is growing around the world and I feel that the NP/APNN has been a global leader of this major healthcare workforce change. As noted in the seminal policy document that was published last year by ICN, Guidelines on Advanced Practice Nursing, the potential for advanced practice nurses to be immersed in increasing access and improving health system efficiency is enormous. It has become clear that governments will need to recalibrate their healthcare workforce, especially in regard to APNs, in order to better address the need to reduce NCDs and to be able to sustain universal healthcare access. Finally, I would like to offer a special shout out for Melanie Rogers who is the current Chair of the NP/APNN. She is a force to reckon with. I am thrilled to be “paying it forward” as a part of the brilliant dust of her comet that is streaming through the sky. Q: For young students, who aspire to become nurses - what would your advice to them be? A: Do it! While there are ups and downs with every profession, I don't think that there is a profession that holds more opportunity and promise in the 21st Century. ICN NP/APNN COVID-19 update By Marie-Lyne Bournival (NPAPNN – CSG/Communication Sub-group Liaison) At the time of this writing, more than 121 million cases of COVID-19 infections, with more than 2.5 million deaths, have been reported worldwide. In December 2020, ICN announced that more than 1,500 nurses over 44 countries had died from the disease whilst it was estimated that the health workers fatalities globally could be closer to 20,000. As the pandemic still rages, ICN President Annette Kennedy spoke out against the unacceptable inequalities exposed by the COVID-19 pandemic, for the nursing profession, as well as women in general. She discussed the gender bias against nurses exposed by the pandemic. “The lack of investment in, respect for, and abuse of nurses can no longer be tolerated. As we look back on the past year of the pandemic, we see call after call for protection, decent pay and acceptable working conditions for this 90% female workforce being ignored by governments and policy makers all over the world. Women, and especially nurses, have shouldered the majority of the care of the ill and dying, along with increased childcare, yet we see rates of violence and abuse against women are on the rise, and nurses are continuing to put their lives at risk for a low-paid, undervalued job. It is time for our demands to be taken seriously. I am also concerned about the impending exodus from the profession of nurses who have been traumatised by caring for patients with COVID-19. There is a world-wide shortage of six million nurses, and a further four million are due to retire in the next decade. If we factor in the COVID Effect in addition that could leave health services with only half the nurses they currently have if drastic action is not taken. The consequence of this on health systems and economy around the world could be even worse than the pandemic.” ICN has released an online publication detailing month-by-month the work it undertook in 2020 to advocate and lobby for the support and protection of nurses during the COVID-19 pandemic.
Since the start of 2021, much effort has been directed to roll out vaccines against COVID-19. Indeed, by March 2021 close to 400 million doses had been administered. Below are some links that will facilitate the understanding of the process regarding the vaccine from its inception, priorisation and distribution as well as resources. COVAX: https://www.who.int/initiatives/act-accelerator/covax PRIORITIZATION: https://www.who.int/publications/m/item/criteria-for-covid-19-vaccine-prioritization READINESS AND DELIVERY: https://www.who.int/initiatives/act-accelerator/covax/covid-19-vaccine-country-readiness-and-delivery VACCINE TRACKER: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines RESOURCES (multi-language) : https ://who.canto.global/v/Immunization/landing ?viewIndex=0 WHO’s “Science in 5” podcasts: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5 COVID Dashboard: https://covid19.who.int/ Resilience of APNs duringCOVID-19 crisis - An international study By Varsha Singh COVID-19 was an unexpected event for global healthcare providers. Nurses were frontline caretakers as well as bedside nurses. Advanced practice nurses and nurse practitioners experienced remarkable stress while providing care to their patients. We witnessed something unprecedented and still managed to continue to care for our patients. Every healthcare provider had to adapt and sustain their ability to practice and continue to provide care in these challenging circumstances. As a professional international organisation of NP/APN, the members of the ICN NP/APNN were extremely concerned about the impact that COVID-19 was having on their colleagues. Under the leadership of Dr Melanie Rogers, RGN, BSc, MSc, PhD, Queens Nurse, ICN NP/APNN Chair, this study was developed by a group of researchers from the ICN NP/APNN. The group were interested in the experiences of NP/APN/CNS professionally and personally during the COVID-19 crisis. The idea was to understand the spiritual, as well as emotional, wellbeing and resilience of the NP/APN/CNS. It was expected that the participation by the advanced practice nurses would help provide much needed information to understand the impact that COVID-19 has on them. There were specific criteria for the participants: (1) The participant must be an Advanced Practice Nurse (NP/CNS). For example, you may be working clinically, in education, research, policy-making or other related NP/APN work. (2)The participant must be able to read and write in English. (3) The participant must have access to an Internet connection. The survey was shared widely with global membership as a research focused on establishing the impact of COVID- 19 on Nurse Practitioners’ emotional and spiritual wellbeing and resilience. The Florida Nurse Practitioner’s Association shared the survey link using the ‘snowballing’ recruitment method as encouraged by Dr Loretta Ford. The survey received a massive response rate of over 1,500 respondents from all over the world. In this survey a mixed methods approach has been utilised. Quantitative data was collected using three validated scales which are accessed online. The scales used are the Warwick-Edinburgh Mental Wellbeing Scale, the Facit Spiritual Wellbeing Scale, and the Connor Resilience Scale 10 scale. These scales ascertain the emotional and spiritual wellbeing and resilience of healthcare professionals at the time of the research. All the above scales were used after seeking permission from the original sources. Qualitative data were also collected online via a case study template to further understand the impact of COVID-19 on NPs personally and professionally. Although analysis is currently in progress. However, the quantitative results show very low resilience levels of APNs, even lower than patients who suffer with anxiety or PTSD. There is an urgent need to provide some intervention to support APN resilience, especially as we move into the second or third wave of COVID-19 globally.
ICN NP/APNN is looking forward to analysing the data as well as utilising the preliminary results towards future programmes for NP/APN focused on addressing emotional and spiritual wellbeing. 11th ICN NP/APN Network Conference goes virtual By Sini Hämäläinen Due to the global pandemic situation, the 11th ICN NP/APNN Conference was postponed to 2021. Now after a year's wait, the conference will be held virtually on 29 August - 1 September 2021. The conference is one of the largest international meetings on advanced practice nursing. With more than 1000 delegates, the conference promises to be an exciting and rewarding opportunity to learn together. It seeks to set the foundation for developing and expanding the reach and impact of the next generation of NPs and APNs. The conference theme is Envisioning Advanced Practice Nursing Beyond 2020: Wider Reach, Bigger Impact which was deeply inspired by Florence Nightingale, who by today’s standards would have been the world’s very first advanced practice nurse. As Florence once said, “For we who nurse, our nursing is something which, unless we are making progress every year, every month, every week, we are going back. No system shall endure which does not march.” Thus, the theme challenges us to look forward and to set the foundation for developing and expanding the reach and impact of the next generation of NPs and APNs. Conference sub-themes build on ICN’s strategic priorities and the United Nations’ Sustainable Development Goals to examine progress and future directions for NPs and APNs towards addressing the health needs of populations. The conference programme provides a thorough view on global aspects of advanced practice nursing. Moreover, the conference will be a great opportunity for students to learn from leading APNs, access over 200 scientific sessions and network with other students from around the globe. There will be dedicated student sessions and discussion round tables to connect. In addition, the ICN NP/APNN will recognise four APNs with an Excellence Award in the field of Leadership, Education, Research and Clinical Practice. Registration is open now! For more information, visit https://npapn2021.com/. International Council of Nurses 3, Place Jean Marteau 1201 Geneva Switzerland
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